Cyclone Pam, Vanuatu - WHO Western Pacific Region
Transcription
Cyclone Pam, Vanuatu - WHO Western Pacific Region
28.03.2015 HEALTH CLUSTER BULLETIN, ISSUE #1 Cyclone Pam, Vanuatu Lenekel Hospital Building, Tanna Island (WHO/A. Craig) Health Sector Updates: Highlights: 24 Health Cluster Partners 30 of the 41 assessed health facilities (HFs) All 6 Provincial hospitals are functioning have been damaged, the assessment of the 10 500 Targeted population for measles mass remaining 29 health facilities led by the vaccination campaign (with vitamin A Ministry of Health (MoH) is on going and will be distribution and deworming), and 7500 concluded by 29 March vaccinated as of 26 March Emergency evacuations of 48 patients from $4 920 000 requested through Flash Appeal the worst-affected islands to Vila Central for the overall health and nutrition responses Hospital occurred between 18 and 26 March $ 1.200 000 allocated to health agencies from 13 Foreign Medical Teams (FMTs) currently CERF supporting MoH deployed to affected islands (Tanna, Efate, Pentecost, Ambrym, Shepherd, Impact on the affected population: including Togariki, Tongoa and Epi) 158 000 people affected on 21 Islands MoH Central Medical Store is restocking 11 confirmed deaths medicines and medical supplies From over 3800 people displaced in 36 5 Inter Agency Emergency Health Kits evacuation centers on 13 March, 295 still in (IEHK) and 3 Diarrhoeal Disease Kits (IDDK) 11 evacuation centers on 27 of March arrived 24 March, out of which and two IEHK 75 000 people in need of shelter shipped to Tanna on 25 March 110 000 people without access to safe drinking water 2 Context Over half the population affected Tropical Cyclone Pam has been described as the strongest cyclone in the Pacific in more than a decade. The cyclone ravaged Vanuatu, battering the country with winds over 250 kph, and 1 meter high storm surges. Neighboring Pacific Island countries, Kiribati, Solomon Islands and Tuvalu were also impacted by the storm. To date, the number of total fatalities due to Cyclone Pam is 11. While the impact of the cyclone resulted in a limited number of casualties, the number of injuries presenting at health facilities are significant, and they growing during the second week of the response. Severe damage to health system The cyclone has affected over 158 000 of Vanuatu’s population, representing more than half of the total population of the country, causing widespread and severe damage throughout the country, particularly in the central and southern regions, which experienced the brunt of the storm. Over 3,000 people were displaced from their homes in the capital Vila alone, some are gradually going back home, however, a large number of people remain without a home, displaced in either evacuation centres and/or hosted in communities. The impact of the cyclone on the health system has been huge. One major consequence is the severe disruption of health service delivery, mainly due to damaged health facilities, interruption of telecommunications, road and sea transportation, and the disruption of water and energy supplies. Damage assessments to health facilities are ongoing. With telecommunications coming back online Of the 41 health facilities assessed, 30 are damaged. We expect more than 30 health facilities will require reconstruction/rehabilitation once all assessments are completed. Public Health Risks Communicable Diseases Measles: Measles outbreaks are common following natural disasters due to displaced populations, overcrowding and interruption to routine vaccination schedule. In 2013, measles vaccination coverage in Vanuatu was estimated to be 53% in the under-five year age group. There have been two outbreaks of measles in Vanuatu in the past year (on Efate). Although catch-up vaccination campaigns were conducted in 2014, measles confirmed cases continue to be reported in Port Vila, while suspected cases are reported from Santos, and Tanna. The risk of a measles outbreak is high. Respiratory infections: It is estimated that 11% of deaths each year in children <5 years in Vanuatu are caused by pneumonia. Re-establishment of health infrastructure for early detection and treatment of suspect pneumonia, and the capacities of secondary level of care to treat the cases of severe pneumonia will reduce the related mortality. 3 Diarrhoeal disease: Large post-disaster outbreaks of diarrhoea have been documented in the Pacific, such as after flooding in the Solomon Islands in 2014. Children are particularly vulnerable. Safe water and food, along with appropriate sanitation and hygiene, will reduce the risk of diarrhoeal disease outbreaks. Leptospirosis: Leptospirosis currently occurs on a sporadic basis in Vanuatu. Outbreaks of Leptospirosis commonly occur following flooding events, and situations in which people are crowded in areas where rodents may also live. One death from suspected leptospirosis was reported from the Vanuatu Central Hospital at the time of the cyclone; in this case, leptospirosis would have been contracted prior to the cyclone. Vector-borne disease (VBD): Vector-borne disease (VBD) outbreaks, such as dengue, chikungunya, Zika or malaria are more likely in post-disaster situations. Malaria is endemic in most islands in Vanuatu, which has an overall Annual Parasite Incidence (API) of 13.2 per 1,000 (2012). Transmission is generally higher in the northern provinces, which generally report higher API (API of 38.2 was reported on Torba, and 20-21 per 1,000 was reported in Malampa, Penama and Sanma in 2012) than the southern provinces (API of 4.7 per 1,000 in Shefa and 0.4 per 1,000 in Tafea in 2012). Other Health Concerns Nutrition: While the pre emergency levels of wasting are low, cases of severe wasting are likely to increase due to the compromised food, water and health systems. In particular, the destruction of food crops has significant implications for nutrition over the coming year, until food stocks are restored. Protection and promotion of breastfeeding and adequate complementary feeding is essential to ensure that women are able to continue breastfeeding under stressful conditions and young children receive nutritious foods for critical growth and development. The most urgent needs for nutrition are to protect and promote breastfeeding; identify and treat children who are severely wasted, deliver communication on child and maternal nutrition in emergencies and to ensure that the food ration is nutritionally adequate and accessible by children and pregnant and lactating women. After the immediate emergency phase, micronutrients for children 6-59 months will be distributed. Maternal and Child Health: As a result of the cyclone, destruction of health facilities has limited access to reproductive health services, including maternal health services and response to genderbased violence. Based on the MISP calculator and 2013 DHS and 2009 census data of the four most affected provinces, and the Vanuatu National Survey on Women’s Lives and Family Relationships, priority areas of lifesaving assistance have been identified: • Women of reproductive age = 56,147 • Estimate of currently pregnant women = 6,738 • Estimate of women who may experience pregnancy related complications in the next month = 100 • Estimate of women who may experience pregnancy related complications in the next 9 months = 900 • GBV figures are best estimated from the VAW prevalence studies. Recent violence against women prevalence data shows 60 per cent of women experience physical and sexual violence committed by an intimate partner in their lifetime and 48 per cent of women and girls aged 15 and above experience physical and/or sexual violence committed by a nonpartner. A further 30 per cent of girls below the age of 15 years, experience sexual abuse, with more than one in four women (28 per cent) reporting that their first sexual experience was forced. 4 Health Sector Priorities and initial response 1. HEALTH FACILITY ASSESSMENTS: The health facilities’ assessment in the affected areas is led by the MoH with support from all health cluster partners engaged in the response. The Health Cluster is involved with the established Infrastructure working group, conducting damage assessments of all health facilities and has provided teams to assess the extent of repairs/public works required. To ensure consistency, a tool was developed for health cluster partners to use in order to reflect the level of damage health facilities. To date, over 41 HFs have been officially assessed, of this, 30 HFs are damaged to varying degrees. 2. RESTOCKING OF MEDICINES AND MEDICAL SUPPLIES: The immediate push – dispatch of routine medical supplies to provincial health offices by the Central Medical Store (CMS) is being complemented by the allocation of Inter Agency Emergency Health Kits to the most affected areas. With communication to provincial Offices and individual health facilities it will become easier to respond to gaps and identify low stocks. 3. DISEASE SURVEILLANCE AND RESPONSE: The aftermath of natural disasters often result in disease outbreaks due to overcrowding in evacuation centres, and lack of water and sanitation to the affected/displaced population. 16 sentinel sites are being established in addition to the 8 already existing ones to monitor the public health situation. In addition event based surveillance is taking place in evacuation centres and at all functioning health facilities. 4. MEDICAL EVACUATIONS: 48 medical evacuations took place since the onset. 5. URGENT REPAIRS TO HEALTH FACILITIES: Cyclone Pam left a path of destruction including damaging health infrastructure in 4 Provinces. Urgent repairs on health facilities will be a priority for the coming weeks and months. There are 70 health facilities on islands affected by cyclone Pam, excluding aid posts. Assessments have been conducted in 41 facilities (table 1), the remaining assessments will be available in the next few days when teams return from the field. Of the 41 facilities that have been assessed there were 11 facilities that have very severe damage and severe facilities with severe damage (table 2). Limited damage was reported in 19 facilities and there was no damage reported from 11 facilities. All assessed health facilities remain operational except for five; Imere, Teiwaikara (Efate), Amboh (Tongariki), Tavalapa (Tongoa) and Kitow (Tanna). Foreign medical teams are providing primary health care in Tongoa, and Tongariki where all existing health facilities are severely or very severely damaged. Tanna has 4 health facilities reported as being severely or very severely damaged: Ikiti dispensary and Kitow health centre (very severe), and Lenekal hospital and Greenhill health centre (severe). With the exception of Kitow these facilities are still functioning. Foreign medical teams are supporting health care delivery in Tanna. 5 Table 1. Damage to health facilities by health facility type on affected islands, Vanuatu, March 2015. Type of facility Total Health Damage Hospital centre Dispensary No damage 4 7 11 Limited 1 4 14 19 Severe 1 5 1 7 Very severe 1 3 4 Not assessed 5 24 29 Total 2 19 49 70 Table 2. Health Facilities severely or very severely damaged, by island and province, Vanuatu, March 2015 Province Island Health Facility Damage Malampa Ambryn Utas Severe Shefa Efate Paunangisu Severe Tongariki Amboh Very Severe Tongoa Silimauri Severe Tongoa Tavalapa Very Severe Epi Port Quimmie Severe Epi Vaemali Severe Tafea Tanna Ikiti Very Severe Tanna Green Hill Severe Tanna Kitow (Nagus Kasaru) Severe Tanna Lenakel Very Severe INITIAL RESPONSE: Ministry of Health: WHO is working with the Vanuatu Ministry of Health to co-chair the Health Cluster, bringing together multiple health partners including foreign governments, NGOs and UN agencies in a coordinated response to this Grade 2 Emergency. Frequent meetings are taking place in Vila to ensure all health partners are informed and the response is well integrated in the overall humanitarian response to Cyclone Pam. Sub-working groups have been established to coordinate public health matters, nutrition, Information, Education and Communication activities and reproductive health. The MoH and AUSMAT, with support from Foreign Medical Teams (FMTs) and the military, have assisted with the medical evacuation of 48 people requiring tertiary medical care of which 16 patients were ≤ 5 years and 32 patients were ≥ 5 years. The routine referral system is currently hampered by a lack of functioning health facilities in affected areas, limitations in communication networks, and lack of access and availability of transport. There are an estimated 100 more emergency medical evacuations that may take place over the course of the coming days and weeks. International Organization for Migration (IOM) is supporting the MoH in the repatriation of referred patients at the end of their treatment. 6 LOCATION Medivacs per location TONGOA TONGARIKI TANNA PAAMA MATASO IS EPI BUNINUA IS BUNIGA ANIWA IS AMBRYM AMBAE 0 2 4 6 8 10 12 14 16 18 20 Total Number of Medivacs per location The average daily number of patients treated to the trauma clinic of VCH increased to more than 70 per day, this number is not expected to decrease soon, most of the patients are presenting with untreated and infected wounds. The Ministry of Health is leading the implementation of measles vaccination campaigns in Shefa and Tafea Provinces as well as on Santo Island where cases of measles have been reported at the beginning of the year. Mosquito nets are being distributed in Efate and further distributions are planned in the affected areas to replace damaged nets. Foreign Medical Teams (FMTs): A total of 13 foreign medical teams (FMT) are supporting the MoH in the emergency response, 2 more FMTs are finalizing registration and will be deployed in priority areas immediately after. The coordination of those is strongly supported by AUSMAT. Some of the early arriving FMT’s are approaching the end of their presence in Vanuatu while others are coming in, able to bridge the gaps. The departure of FMTs is of great concern as a drop in health care service provision must be expected while the demand for health care is expected to remain high and the existing health services will require time to recuperate from the disaster. 7 # 2 (Fixed & Mobile) 24 1 (Mobile) 8 Foreign Medical Team deployment Status Location Vila Central Hospital, Demobolised Efate Abwatuntora H/C , Demobolised Pentecost 1 (Fixed) 5 Demobolised 1 (Mobile) 1 (Fixed) 6 10 Deployed - 19/3/15 Deployed - 21/3/15 1 (Mobile) 8 Deployed - 24/3/15 1 (Mobile) 6 Deployed - 26/3/15 1 (Mobile) Yacht 5 Re-Deployed - 24/3/15 1 (Mobile) 3 Planned - 30/3/15 1 (Mobile) 3 Planned - 30/3/15 1 (Mobile) 8 Deployed - 24/3/15 Specialist (Fixed) 8 Deployed - 20/3/15 Specialist (Fixed) 5 Deployed - 21/3/15 14 French Military 1 (Mobile) 2 16 Promedical 11 Team AUSMAT 1 (Australia) JICA Medical 2 (Japan) Humedica 3 (German) Samaritan's 4 Purse (USA) 5 Rescue Net NYC Medics 6 (USA) International 7 Medical Corps 8 Dragonfly (USA) HUMA Primary 9 care (Japan) HUMA Public 10 Health (Japan) Fijian Military 11 Medical team HSL Medical 12 (Pacific) JICA Surgical 13 team FMT type Specialist (Mobile) Team Tanna (Lenakel Hosp) Tanna (Lenakel Provincial Office) Pt Resolution, Tanna Silumauri Health Centre, Tongoa Utas Health Centre, Ambrym Tafea ; Erramongo, Futuna, Aniwa, Aneytum Duration 14 days Remarks Deployed 16/3 28/3/15 Deployed 21/3 27/3/15 Deployed 19/3- 27/3/15 - replacement Fijian Military Medical team 1 month 10 days departing 16/4 ? departing 30/3 ? 10 days departing 15/4 ? 14 days departing 9/4 ? 5 days resupply Vila 14 days 10 days Paungangisu Clinic, Efate 10 days MOH Vaccination team Tanna 10 days departing 15/4 14 days departing 10/4 14 days departing 4/4 10 days departed 27/3 Deployed - 19/3/15 Lenakel Hospital, Tanna Vila Central Hospital, Efate Vila Central Hospital, Efate Whitegrass Airfield, Tanna Working Vila, Efate Permanent ?? pre-hospital ambulance / emergency response departing 15/4 World Health Organization (WHO): To support the MoH and the WHO Country Office, WHO deployed 1 Regional Adviser on Disaster Response Management, 1 Health Cluster Coordinator, 2 Risk communication officers, 4 epidemiologists, 1 administrative assistant and 1 logistician to support response efforts WHO established a forward post in Lenakel, Tanna Island, to support the MoH Health Cluster's response activities on the Island. Current health activities that the clusters Tanna-based forward post is supporting include: the establishment of Early Warning Alert and Response Network (EWARN) sites of Lenakel Hospital, Whitesands Health Facility and Green Hills Health Facility micro-planning and (next week) implementation of a measles vaccination, Vit A supplementation and deworming campaign for 0.5 to 5 year olds receipt, stock management and distribution of International Emergency Health Kit's contents (primarily essential medicines) to health facilities across the island support of community-based health risk communication messaging through networks of chiefs, churches, youth and women’s groups coordination and provision of Provincial Health Department transportation and logistics function. WHO through the government of the Solomon Islands provided 5 Inter-Agency Emergency Health Kits (IEHK) and 3 Inter-Agency Diarrhoeal Disease Kits (IDDK) which arrived 24 March. 2 full IEHKs were sent to Tanna the same day, enough to provide primary and secondary health needs to 20 000 people for 3 months. These kits allow the continued provision of primary health care services. Distribution of kits to the outer islands is scheduled to occur in the coming days. 8 The MoH, supported by WHO, have initiated an Early Warning Alert Response Network (EWARN) in 24 sentinel sites in Vanuatu, 16 of which are already functioning. The EWARN system is designed for the timely detection of outbreaks to allow for immediate investigation and control and to prevent further disease spread. In addition event based surveillance (EBS) is being conducted in evacuation centres and ultimately in all active health facilities. Clinicians, foreign medical teams and NGOs were requested to report any unusual events to MOH and WHO. To date, 13 alerts have been received. Nine alerts were able to be verified. None were significant public health events .Three children were referred to health facilities for assessment. We were unable to verify four events as contact details were not available however foreign medical teams are on the islands affected in the event there is a need for investigation. Risk communication also falls under this priority and is currently taking place to mitigate the risk of disease outbreaks. Public Health Messages have been disseminated via radio spots and print media is frequently disseminating health and hygiene messages. Mass text messaging will start in the coming weeks aiming to reach the population across the whole archipelago. A communications subgroup (also part of the HC) has been formed in order to streamline health messages among partners to avoid duplication and contradiction in messaging. Already developed IEC materials, translation capacity, access to existing local networks to facilitate community engagement and awareness for PH messages. Australian Medical Assistance Team (AUSMAT) The AUSMAT team has been embedded at the Vila Central Hospital (VCH) From soon after the emergency and supported the various technical wards alongside the hospital staff and strengthened the hospitals capacity in the management of the crisis. AUSMAT provided additional 3 tents to increase the surgical ward capacity. AUSMAT took the lead in supporting the MOH in coordinating the incoming FMT’s and provided strong support in air medical evacuations. Save the Children (STC): STC is planning to support the vaccination campaign on Santo Island including vit. A, deworming, and IYCF messaging. Micro-planning is ongoing with MoH, WHO and UNICEF in response to an outbreak reported earlier this year on the island. Save the children is assessing aid posts in Efate in order to provide support in their rehabilitation and ensuring the village health worker network is being revitalized after the cyclone. STC staff was trained on IYCFE to conduct community nutrition activities integrated with WASH. World Vision International: Planning to support the vaccination campaign on Tanna Island, micro-planning is ongoing with MoH, WHO and UNICEF. Action to start next week. UNICEF: The most urgent needs for nutrition are to protect and promote breastfeeding; identify and treat children who are severely wasted, deliver communication on child and maternal nutrition in emergencies and to ensure that the food ration is nutritionally adequate and accessible by children and pregnant and lactating women. After the immediate emergency phase, micronutrients for children 6-59 months will be distributed UNFPA: UNFPA is implementing both health and protection related sexual reproductive health and GBV prevention and response, in coordination with Ministry of Health and key NGO partners. 9 The health response includes outreach, distribution of MISP RH kits and implementation of the MISP package of services around maternal health and GBV response. In addition, the protection response complements the health response in assisting referral of survivors to healthcare to meet critical lifesaving needs especially in remote areas where access to health services has been disrupted and community based organizations must be mobilized for outreach to support referrals and response. A group of NGOs including Save the Children and Medicine du Monde and CBO’s, under the Vanuatu NGO network, VANGO, as well as youth and women’s groups that participate in the Protection and Heath Clusters as well as long-time partners of UNFPA have been consulted around programming interventions. Future response: Priority Activities o Assess and monitoring health needs during the different phases of the response to the disaster to inform planning of health interventions o Enhance coordination of international and national partners within and outside the health sector o Deliver equitable and quality health services for acute and chronic conditions to all affected population through temporary and permanent health facilities, and mobile teams, while repairing, rebuilding, or relocating damaged health facilities o Deliver quality health services for obstetric and neonatal emergencies, family planning antenatal and postnatal care, and adolescent reproductive health o Provide psychosocial support services and early detection and treatments of mental disorders o Reinforce and expand early warning systems for detection, verification and response to outbreaks o Provide targeted public health information, education and communication campaigns on priority health issues o Re-establishment of routine immunization including cold chain capacity, and measles mass immunization campaign in hot spot areas o Provide urgent nutrition support to treat and prevent deterioration of nutritional status through delivery of infant and young child feeding support, treatment of severe acute malnutrition and provision of micronutrients. 10 Health Challenges Increased access to affected areas located in the most remote parts of the island is reflected by the continued emergency medical evacuations of trauma patients still observed during the second week of the response. Evidence of this is the increased influx of patients from the outer islands, presenting at the Vila Central Hospital (VCH) trauma clinic at an average of over 70 patients daily. Substantial damages on the health system had been identified and addressed during the first 2weeks of the relief operations by the MoH with the support of Health Cluster partners, across the 6 priority areas presented above. The contributions of the Foreign Medical Teams (FMTs) have been essential , providing life-saving health services in the most affected areas. Some of these FMTs have signaled their departure from the country only after 2 weeks since the tropical cyclone hit. At present, the local health systems are not in a position to replace the FMTs in all affected areas in country. New FMTs scheduled to replace those departing are critical to response efforts. The significant decrease in the emergency clinical services at primary and secondary care levels in the most affected and remote areas would detrimentally impact the already compromised national health system. Ongoing health facility assessments will be concluded over next two days, providing with it an overall picture of the level of structural damages to facilities. It important to note that damage to infrastructure is only one component of overall health capacity and health service delivery. The human resource limitations that characterize the national health workforce make it a challenge to deal with the increased health needs of the affected population. The deployment of the FMTs is an important but short-term solution. To ensure the rebuilding and strengthening of the national health system, medium-term solutions must be identified and an overall health sector strategic response plan developed in the next few days, with an implementation timeframe over the next 6 to 9 months. The early recovery element of the Health Sector Strategic Response Plan is critical. Recovery is an opportunity for the country to not only restore its damaged health system but to , “build back better” . Allowing pre-event health inequalities to be addressed while rebuilding local health systems and supporting the Provincial Health Offices in defining and implementing the provincial plans, in line with the MoH decentralization policy presented in the National Health Sector Strategic Plan. 11 Funding status of action plan TABLE 2: FUNDING STATUS OF ACTION PLAN FOR HEALTH US$ Project Appealing Agency 1. Restoration and improvement of health services and public health interventions in cyclone affected areas 2. Re-activation of Expanded Program on Immunization for population affected by Tropical Cyclone Pam in Vanuatu and at risk areas 3. Reproductive Health response including maternal health and GBV response TOTAL Required Funding CERF WHO and Health Cluster Partners 3,024,000 600 000 UNICEF 700,920 350 000 UNFPA 480,000 220 00 1.170.000 USD 12 HEALTH CLUSTER CONTACT LIST Name Viran Tovu George Taleo Organisation Ministry of Health (MOH) Ministry of Health (MOH) E-mail address vtovu@vanuatu.gov.vu gtaleo@vanuatu.gov.vu Phone 7745120 Richard Leona Jean Jaques Rory Danjeck Tari Henry Lakeleo Jameson Mokoroe Basil Leodoro Ministry of Health (MOH) Ministry of Health (MOH) Ministry of Health (MOH) Ministry of Health (MOH) Ministry of Health (MOH) Ministry of Health (MOH) rleona@vanuatu.gov.vu jrory@vanatu.gov.vu djtari@vanuatu.gov.vu hlakeleo@vanuatu.gov.vu jmokorow@vanuatu.gov.vu bleodoro@vanuatu.gov.vu 7754499 7745450 7721383 7750998 7745286 7732177 Margaret Solomon Evelyn Emille Saiven Timbaci Wilson Lilip Eleanor Sullivan Mark Duncan Ministry of Health (MOH) Ministry of Health (MOH) Ministry of Health (MOH) Ministry of Health (MOH) Ministry of Health/ AICEM Ministry of Health/ AICEM msolomon@vanuatu.gov.vu emile@vanuatu.gov.vu stimbaci@vanuatu.gov.vu wlilip@vanuatu.gov.vu ppaaicem@uq.ed.au npaaicem@uq.edu.au 7778560 7743895 7748903 5915557 5432585 7761543 Scott Monteiro Nish Vivekananthan Peter Wallace Chris Hagarty Jacob Kool Nevio Zagaria Ministry of Health/ VHRM Ministry of Health/ VHRM Ministry of Health/ World Bank Health Cluster Information M. Liaison at NDMO World Health Organization (WHO) World Health Organization (WHO) smonteiro@vanuatu.gov.vu; scott@beacon.vu nvivekananthan@vanuatu.gov.vu pwallace@vanuatu.gov.vu malolava1@gmail.com koolj@wpro.who.int zagarian@wpro.who.int 7799921 5432963 7738085 5551012 5568527 5478083 Achyut Shrestha Tiff Cool Adam Craig Christophe Delaude Jennie Musto World Health Organization (WHO) World Health Organization (WHO) World Health Organization (WHO) World Health Organization (WHO) World Health Organization (WHO) shresthaa@wpro.who.int coolc@wpeo.who.int craiga@wpro.who.int delaudec@wpro.who.int mustoj@wpro.who.int 5466621 5478082 7753234 7753233 7753237 Ina Bluemel Jean-Olivier Guintran Michael Buttsworth World Health Organization (WHO) World Health Organization (WHO) World Health Organization (WHO) bluemeli@wpro.who.int guintranj@wpro.who.int buttsworthm@wpro.who.int 5474803 7762910 5388052 Rosie Mohr Rufina Latu Tony Kolbe Clare Huppatz Louisa Tokon Myriam Abel World Health Organization (WHO) World Health Organization (WHO) World Health Organization (WHO) World Health Organization (WHO) WHO/ Ministry of Health WHO/ Ministry of Health rosiemohr@gmail.com latur@wpro.who.int kolbea@wpro.who.int huppatzc@wpro.who.int louisatokon@gmail.com mabel@vanuatu.gov.vu 7116784 5376820 5479522 5479523 5418192 7790849 Rex Thomas George Worwor Bronte Martin Kevin Smith Cameron Noble Elena Fontaine WHO/ Ministry of Health WHO/ Ministry of Health AusMAT (Medical Assistance Team) DFAT (Government of Australia) DFAT (Government of Australia) DFAT (Government of Australia) trex@vanuatu.gov.vu gwwhealth@gmail.com bronte.martin@nt.gov.au kevin.smith@dfat.gov.au cameron.noble@dfat.gov.au elena.fontaine@dfat.gov.au 5477597 5358863 7752652 5543972 Tim Gill Debbie Sorensen Kiki Maoate Melissa Fidow Tei Asai Ricardo Bow DFAT (Government of Australia) Health Specialists Ltd Health Specialists Ltd Health Specialists Ltd Humanitarian Medical Assistance HuMA IDA Foundation Pacific timothy.gill@dfat.gov.au debbie@healthspecialists.co.nz kiki@healthspecialists.co.nz melissa@healthspecialists.co.nz asaiatom@googlemail.com ricardo@idapacific.org Anne-Maree Delaney Ellis Lee Kay Mattson Nathalie Vian Jacob Schafer Serena Chong IFRC IFRC French Red Cross French Red Cross International Medical Corps International Medical Corps annemaree.delaney@ifrc.org health.redcross@gmail.com kdmattson@outlook.com jmvian@lagoon.nc jschafer@InternationalMedicalCorps.org serenachong@gmail.com Ken Iserson Yoko Asano Junko Saito Otomo Hitosh International Medical Corps JICA (Government of Japan) JICA (Government of Japan) JICA (Government of Japan) kvi@u.arizona.edu asano.yoko@jica.go.jp 5547354 6421502887 64212269534 7740850 6799999691 687782708 5475676 5477956 5523678 otomo-hitoshi2@jica.go.jp 14 Takahiro Yokota Timothy Tan Kathy Bequary JICA (Government of Japan) NYCMedics NYCMedics yokota.takahiro@jica.go.jp tim@nycmedics.org kathy@nycmedics.org Martin Buet Jennifer Bose Pakoa Rarua Michael Benjamin Mark Cockburn Joyce Chiles NZMAT (Medical Assistance Team) UN OCHA NDMO ProMedical RescueNet Samaritan's Purse bosej@un.org prarua@vanuatu.gov.vu michaelbenjamin@promedical.com.vu markcockburn@rescuenet.net jchiles@samaritan.org Nichola Krey Maha Muna Gideons Mael Claire Davies Nahad Azodi Ridwan Gustiana Save the Children Australia (SCA) UNFPA UNFPA UNFPA UNICEF UNICEF nichola.krey@savethechildren.org.au elmuna@unfpa.org mael@unfpa.org cdavies@unfpa.org nsadrazodi@unicef.org rgustiana@unicef.org Lepani Waqatakuseina Megan Gayford Shyam Pathak Raul Schneider Rod Rhines Vaughan Shanks UNICEF UNICEF UNICEF World Vision Palantir Palantir lepaniw@yahoo.com.au mgayford@unicef.org SPathak@savechildren.org raul_schneider@wvi.org rrhines@palantir.com vshanks@palantir.com Debra Allan Kristina Mitchell Karl Erdmann Astrid Heckmann-Fossier Ray Hingst Rashmi Rita Presbyterian Church of Vanuatu Save the Children AmeriCares Medecins Du Monde Australian Defence Force OCHA, IM Officer debra.allen@vanuatu.com.vu kristina.mitchell@savethechildren.org.vu kerdmann@americares.org astridfossier@hotmail.com Zoe Ayong Sofia Lardies Helen Johnson Bobbi Twist NDMO Planning Officer WASH Cluster ARC Health Delegate in Tanna New Zealand Defence Force zayong@vanuatu.gov.vu sofia.lardies@livelearn.org oldgrowth3@hotmail.com nzbobbi.twist@nzdf.mil.nz 5473039 5473174 5353983 25566/ 7745566 7118023 7774412/ 5986894 5433557 5477399 5457516 5477800 5977399 7779239 7742736 7737118 7713851 5472165 5471507 5474867 Rita@un.org 5478736, 7775703 15 16